title: [Surgical treatment of metastatic urothelial carcinoma of the bladder: Review of the Cancer Committee of the French Association of Urology].
abstract: BACKGROUND
  The role of surgery in the treatment of patients with metastatic urothelial bladder cancer is controversial. The aim was to review situations where surgical resection of the bladder tumor and/or metastatic urothelial carcinoma has been reported and analyze its results.
  
  
  METHODS
  A bibliographic research in French and English using the keywords BCG, bladder cancer, metastases, cystectomy, metastasectomy, radiotherapy, curative treatment and palliative treatment was performed, 177 articles have been reviewed, and 18 have been selected.
  
  
  RESULTS
  Synchronous or metachronous urothelial carcinoma metastases were diagnosed in 4 and 50% of the cases, respectively. The surgical treatment of metastatic urothelial carcinoma of the bladder has been proposed to achieve oncologic resection of all detectable lesions after a first-line chemotherapy or to treat symptoms, which were refractory to other treatment modalities. In achieving complete resection of the primary tumor and metastases after MVAC chemotherapies, the 5years overall survival was 28%.
  
  
  CONCLUSIONS
  There was no evidence in favouring surgical treatment of metastatic urothelial carcinoma. Considering the high perioperative mortality rate of cystectomy in imperative indications, particularly in the case of hematuria, all therapeutic alternatives must have been exhausted and urine derived in the simplest way.
authors.affiliation: Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40, rue Worth, 92150 Suresnes, France. Electronic address: y.neuzillet@hopital-foch.org.
authors.forename: Y
authors.initials: Y
authors.lastname: Neuzillet
authors.forename: S
authors.initials: S
authors.lastname: Larré
authors.forename: E
authors.initials: E
authors.lastname: Comperat
authors.forename: M
authors.initials: M
authors.lastname: Rouprêt
authors.forename: G
authors.initials: G
authors.lastname: Pignot
authors.forename: N
authors.initials: N
authors.lastname: Houede
authors.forename: H
authors.initials: H
authors.lastname: Quintens
authors.forename: H
authors.initials: H
authors.lastname: Wallerand
authors.forename: C
authors.initials: C
authors.lastname: Roy
authors.forename: M
authors.initials: M
authors.lastname: Soulie
authors.forename: C
authors.initials: C
authors.lastname: Pfister
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000556:secondary* / Q000601:surgery*; D015653:Cystectomy; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Carcinome urothélial; Chemotherapy; Chimiothérapie; Cystectomie; Cystectomy; Metastasectomy; Metastases; Métastasectomie; Métastases; Urothelial carcinoma